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General NPI Number Information
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NPI Number | 1457457947
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Entity Type | Organization
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Legal Business Name | EXCELDENT OF OCEANSIDE
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Dates
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Enumeration Date | 09/15/2006
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Last Update Date | 05/14/2009
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Provider Practice Location Address
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Address Line | 2940 LINCOLN AVE SUITE 101
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City | OCEANSIDE
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State | NY
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Zip | 11572-2195
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Country | US
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Telephone | 516-766-6780
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Fax | 516-678-7794
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Provider Business Mailing Address
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Address Line | 2940 LINCOLN AVE SUITE 101
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City | OCEANSIDE
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State | NY
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Zip | 11572-2195
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Country | US
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Telephone | 516-766-6780
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Fax | 516-678-7794
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DARRELL GINSBERG
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Credential | DMD
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Telephone | 516-766-6780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051059
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License Number State | NY
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